The awesome human factor

Recently I watched the movie Sully. It was the first time I'd ever watched a movie on its actual release date. Knowing what a legendary actor Tom Hanks is, and what a fascinating and near-tragic story unfolded on Jan. 15, 2009, I felt confident that my choice to venture out to the cinema on a beautiful Boston September evening, would be a good one. The movie sure didn't disappoint. Brilliantly directed and acted, the viewer learns about the series of events that unfolded after US Airways flight 1549 encountered a flock of Canada geese 3 minutes into the flight, causing catastrophic bilateral engine failure. Captain Chesley Sullenberger, who had a lifetime of aviation experience (and a keen interest in airline safety) heroically guided the stricken plane into the Hudson. Miraculously, everyone survived—and the rest is history.

The movie guides us in detail through the subsequent events, when the National Transportation Safety Board (NTSB) investigates what happened and whether Captain Sullenberger could have made it back to the airport safely instead of landing in the freezing Hudson River. I have read conflicting reports about whether the NTSB was as harsh in their initial assessment as the movie makes out, but as the story unfolded, the viewer was left with the feeling that it was the hero Captain Sully versus an uncompromising and mean-spirited safety review panel.

One theme that comes up a lot in Sully, and is passionately defended by Captain Sullenberger, is the “human factor.” Hindsight is always 20-20, and everyone is always the wiser afterwards. This does not mean that we shouldn't investigate and analyze, but the problem with the so-called experts' initial analysis of Flight 1549, was that an engine-failure so soon after take-off was completely unprecedented, and nobody could confidently say how a human being would respond.

It turns out that the computer simulations that were used by the NTSB were incorrectly stating that a pilot could have made it back safely to a runway. In actuality however, only after a large number of attempts, did any simulator pilot make it back safely (and that was using the assumption that they knew immediately what had happened and what to do). Captain Sullenberger's defense of his own actions turned out to be right, and it was in fact only the human factor i.e. Captain Sully's actions, that saved the lives of all 155 people on board. Turns out no computer would have done that.

As the term “human factor” kept coming up in the movie, it got me thinking again about the health care comparison, and how it's really only that which puts the “care” into health care. In my capacity as a doctor, and all the other work I do in the entrepreneurial, writing and consulting realms—I meet so many people who are involved at the peripheries of healthcare. Technologists, start-up folk, “Big Data” people and yes, regulators and administrators—and there's 1 common theme that unites all of them. When you talk to most of them (and again, I hate to generalize, but for most of them it's true), they appear to have little understanding of the frontlines of medicine and the heroic work that goes on day in and day out. To them, medicine is all about numbers, outcomes and population health. The whole agenda appears to do everything possible to completely take out the “uncontrollable human factor.”

The problem with this perspective is that health care is different from any other industry, and this “helicopter view” doesn't quite make the cut. Caring for people is not like running a factory assembly line or operating a large automated machine. Whether we are talking about individual doctor-patient (or even nurse-patient) everyday interactions, or life and death situations such as a patient coding in the hospital—you cannot separate out the science from the human factor in an arena that is so full of very real human emotions. That's why anybody who takes an armchair general or Monday morning quarterback approach is doing the wrong thing. By all means investigate, be thorough, seek to improve, and hold to account any deviation from normal protocol, but never forget the very human side of medicine. The general standards of health care in the United States are already exceptionally high when compared to almost any other country, and the reality is that everyone is so highly trained that really serious mistakes are thankfully rare.

What everyone does in health care is heroic. Doctors, nurses, or any other professional who shows compassion and cares for the sick when they need help, are doing a noble thing. Using your skills to get people better may seem like “just a job” after a bit, but you are having your own Captain Sully moment every time you selflessly dedicate yourself to your patients' wellbeing.

Sitting talking to an elderly patient reminiscing about his Second World War experiences, spending an extra 5 minutes with a family who has had their whole world turned upside down, holding the hand of a dying grandmother who is expressing her biggest regret in life, or calmly facing the parents of a child who has been diagnosed with terminal illness. In health care, the human factor is everything.

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.

Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.
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